肾组织中乙型肝炎病毒抗原检测与IgA肾病的联系

COMPARISON OF CLINICOPATHOLOGIC CHANGES BETWEEN IGA NEPHROPATHY WITH AND WITHOUT RENAL HBV ANTIGENS DEPOSITION

目的 :比较 Ig A肾病 (Ig AN)肾组织中乙型肝炎病毒抗原 (HBAg)阳性和阴性患者的临床与病理特点。 方法 :收集经免疫组化技术检测证实的肾组织 HBAg阳性组 2 6例和阴性组 59例 Ig AN患者的临床和病理及随访资料。 结果 :与阴性组相比 ,阳性组肾病综合征者多见 ,血红蛋白、血清 Ig A水平和肌酐清除率显著下降 ,2 4 h尿蛋白定量显著增加 (P<0 .0 5) ,免疫荧光以 Ig A+Ig G+Ig M型者多见 ,肾组织病理损害以 级为多 ,肾小球硬化、肾小管病变、间质炎症和纤维化程度均显著严重 ,随访期间 2例进入尿毒症期。 结论 :本组观察显示 ,肾组织中存在乙型肝炎病毒抗原的 Ig AN患者 ,临床病理改变较无乙型肝炎病毒抗原者重 ,预后差。

OBJECTIVE To compare the clinopathologic changes between IgA nephropathy(IgAN) with and without HBV antigen(HBAg)deposition in renal tissue. METHODOLOGY 26 cases of IgAN with HBAg deposition(Group 1)in renal tissue and 59 cases of IgAN without HBAg deposition(Group 2)were enrolled in this study.HBAg in renal tissue was detected by immunohistochemical techniques. RESULTS Nephrotic syndrome,IgA+IgG+IgM pattern in immunofluorescent deposits and grade type Ⅳ real lesion were more frequent seen in the Group 1 than Group 2.The concentration of hemoglobin,serum levels of IgA and creatinine clearance rate were significantly lower in Group 1 than in Group 2.Glomerulosclerosis and tubulointerstitial lesion was more severe in Group 1 than Group 2.There were two patients entered the uremic stage in the Group 1 during the follow up. CONCLUSION IgA nephropathy patients with or without renal HBAg deposition have different clinical manifestation and outcome and may belong to two different disease entities.Antiviral treatment might be effective in IgAN patients with HBAg deposition in reanl tissue.